Intracranial astrocytoma in elderly patients

Ampil, Federico L.; Fowler, Marjorie; Kim, Kookmin

doi:10.1007/bf00172661

Cited by 35 publications

(10 citation statements)

References 10 publications

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“…Interestingly, this appeared to have been the path of growth in Case 1. Cerebellar astrocytomas typically appear as cystic hemispheric lesions or as solid tumors with midline (vermis) or paravermian locations 13,14 . The latter type may extend into the brainstem or cerebellar peduncle, or even prolapse into the CPA.…”

Section: Discussionmentioning

confidence: 99%

Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle

Ahn

Jackler

1997

The Laryngoscope

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The vast majority of cerebellopontine angle (CPA) tumors are extraaxial masses arising from either the eighth nerve (acoustic neuroma) or meninges (meningioma). Rarely, a tumor that arises from the brain parenchyma may protrude laterally to present with a clinical and radiographic picture simulating that of the much more common extraaxial lesions. Three individuals with CPA lesions that ultimately proved at operation to be exophytic brain tumors (pontine medulloblastoma, cerebellar astrocytoma, and fourth ventricular ependymoma) are described. The clinical manifestations of these lesions, although not entirely typical, fell well within the possible range of presentation of benign tumors primary to the CPA. In two of these cases the tumor actually penetrated into the internal auditory canal. As the optimal management strategy for treating parenchymal tumors differs substantially from that for extraaxial lesions, it is essential that the surgeon have a preoperative awareness of the lesion's nature before embarking on a surgical endeavor. Critical to arriving at the correct diagnosis is the close examination of preoperative imaging studies. The clinician should be alerted to the possibility that a CPA tumor is of intraaxial origin when the preoperative magnetic resonance imaging scan shows 1) blurring of the margin between the tumor and brainstem or cerebellum; 2) a degree of peritumoral hyperintensity on T2-weighted scans disproportionate to the size of the extraaxial mass; and 3) dilation of the lateral recess of the fourth ventricle.

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Section: Discussionmentioning

confidence: 99%

Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle

Ahn

Jackler

1997

The Laryngoscope

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“…Older patients have a worse survival outcome compared with younger patients (Ampil et al, 1992; Siker et al, 2011). Recursive partitioning analysis of Radiation Therapy Oncology Group (RTOG) glioma trials (Curran et al, 1993), the United Kingdom Molecular Research Council (UK MRC), and European Organization for Research and Treatment of Cancer (EORTC) prognostic groups have consistently shown that elderly patients and those with poor performance do poorly.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated Radiotherapy and Stereotactic Boost with Concurrent and Adjuvant Temozolamide for Glioblastoma in Good Performance Status Elderly Patients – Early Results of a Phase II Trial

Floyd¹,

Kasper²,

Uhlmann³

et al. 2012

Front. Oncol.

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Glioblastoma Multiforme (GBM) is an aggressive primary brain neoplasm with dismal prognosis. Based on successful phase III trials, 60 Gy involved-field radiotherapy in 30 fractions over 6 weeks [Standard radiation therapy (RT)] with concurrent and adjuvant temozolomide is currently the standard of care. In this disease, age and Karnofsky Performance Status (KPS) are the most important prognostic factors. For elderly patients, clinical trials comparing standard RT with radiotherapy abbreviated to 40 Gy in 15 fractions over 3 weeks demonstrated similar outcomes, indicating shortened radiotherapy may be an appropriate option for elderly patients. However, these trials did not include temozolomide chemotherapy, and included patients with poor KPS, possibly obscuring benefits of more aggressive treatment for some elderly patients. We conducted a prospective Phase II trial to examine the efficacy of a hypofractionated radiation course followed by a stereotactic boost with concurrent and adjuvant temozolomide chemotherapy in elderly patients with good performance status. In this study, patients 65 years and older with a KPS > 70 and histologically confirmed GBM received 40 Gy in 15 fractions with 3D conformal technique followed by a 1–3 fraction stereotactic boost to the enhancing tumor. All patients also received concurrent and adjuvant temozolomide. Patients were evaluated 1 month post-treatment and every 2 months thereafter. Between 2007 and 2010, 20 patients (9 males and 11 females) were enrolled in this study. The median age was 75.4 years (range 65–87 years). At a median follow-up of 11 months (range 7–32 months), 12 patients progressed and 5 are alive. The median progression free survival was 11 months and the median overall survival was 13 months. There was no additional toxicity. These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost, and temozolomide.

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“…This, however, does not explain why survival is also reduced in elderly patients without concomitant diseases [9]. (2) The preponderance of a high histological grade of malignancy in old age.…”

Section: Introductionmentioning

confidence: 99%

“…(2) The preponderance of a high histological grade of malignancy in old age. However, a reduced survival in this age band is also observed in patients with a disease with a lower grade of malignancy than glioblastoma [9]. (3) The intrinsic resistance to cancer treatment in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Treatment of High-Grade Gliomas in the Elderly

Brandes

Fiorentino

1997

Oncology

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In recent years the elderly population has grown, and in this category there has been a marked increase in the incidence of cancers with a poor prognosis, brain tumors in particular. However, few authors have focused on treatment for high-grade gliomas in the elderly, which often present problems different from those in younger populations. Several authors have observed that this tumor has a poor response to surgery, radiotherapy and chemotherapy. Elderly patients are therefore frequently undertreated or excluded from cancer therapy trials. Their exclusion from conventional cancer treatment often depends on ad hoc decisions and assumptions by physicians rather than on sound scientific data.

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Intracranial astrocytoma in elderly patients

Cited by 35 publications

References 10 publications

Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle

Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle

Hypofractionated Radiotherapy and Stereotactic Boost with Concurrent and Adjuvant Temozolamide for Glioblastoma in Good Performance Status Elderly Patients – Early Results of a Phase II Trial

Treatment of High-Grade Gliomas in the Elderly

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